How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview

Chien, Patrick; Arnott, Neil; Gordon, A. J.; Owen, Philip; Khan, Khalid S.

doi:10.1111/j.1471-0528.2000.tb11690.x

Cited by 256 publications

(136 citation statements)

References 49 publications

(199 reference statements)

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“…Previous reviews have reported that uterine artery Doppler ultrasonography has limited accuracy in predicting preeclampsia and intrauterine growth restriction. [23][24][25] However, these reviews were restricted in terms of the thresholds and Doppler indices they reviewed or they reported independently pooled likelihood ratios, which is now discouraged.…”

Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

“…22 Two reviews reporting on pre-eclampsia, intrauterine growth restriction and perinatal death were limited to articles retrieved through MEDLINE: one review 23 was based on a search of articles published before January 1997, and the other 24 included patients with unspecified risk in articles up to 2001. A third review, 25 on pre-eclampsia, has been criticized for its methodol- ogy.…”

Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

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Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

627

403

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Background: : Alterations in waveforms in the uterine artery are associated with the development of pre-eclampsia and intrauterine growth restriction. We investigated the predictive accuracy of all uterine artery Doppler indices for both conditions in the first and second trimesters. Methods: :We identified relevant studies through searches of MEDLINE, EMBASE, the Cochrane Library and Medion databases (all records to April 2006) and by checking bibliographies of identified studies and consulting with experts. Four of us independently selected studies, extracted data and assessed study validity. We performed a bivariable meta-analysis of sensitivity and specificity and calculated likelihood ratios. Results:We identified 74 studies of pre-eclampsia (total 79 547 patients) and 61 studies of intrauterine growth restriction (total 41 131 patients). Uterine artery Doppler ultrasonography provided a more accurate prediction when performed in the second trimester than in the first-trimester. Most Doppler indices had poor predictive characteristics, but this varied with patient risk and outcome severity. An increased pulsatility index with notching was the best predictor of pre-eclampsia (positive likelihood ratio 21.0 among high-risk patients and 7.5 among low-risk patients). It was also the best predictor of overall (positive likelihood ratio 9.1) and severe (positive likelihood ratio 14.6) intrauterine growth restriction among low-risk patients.Interpretation: Abnormal uterine artery waveforms are a better predictor of pre-eclampsia than of intrauterine growth restriction. A pulsatility index, alone or combined with notching, is the most predictive Doppler index. These indices should be used in clinical practice. Future research should also concentrate on combining uterine artery Doppler ultrasonography with other tests. Abstract CMAJ 2008;178(6):701-11From the Departments of General Practice (Cnossen, ter Riet, Bindels), of Obstetrics and Gynaecology (Cnossen, Mol, van der Post) and

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Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

Section: Overall Intrauterine Growth Restrictionmentioning

confidence: 99%

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Cnossen¹,

Morris²,

Riet³

et al. 2008

Canadian Medical Association Journal

627

403

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“…Doppler ultrasound determination of uterine perfusion is a noninvasive tool for measuring uteroplacental vascular resistance and assessing the quality of the trophoblast invasion. 2 The trophoblast failed to develop adequately in pregnancies with abnormal uterine perfusion. Trophoblast invasion into the maternal compartment is thus impaired, and the pregnant uterus is not transformed into a low-resistance bed.…”

mentioning

confidence: 99%

Angiotensin II Type 1 Receptor Agonistic Antibodies Reflect Fundamental Alterations in the Uteroplacental Vasculature

et al. 2005

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Abstract-Abnormal uterine perfusion detected by Doppler sonography reflects impaired trophoblast invasion, a factor involved in the pathogenesis of pregnancy complications such as preeclampsia or intrauterine growth retardation. Recent studies have demonstrated an autoantibody against the angiotensin type 1 (AT 1 ) receptor in pregnant women with preeclampsia. Our aim was to determine whether the AT 1 autoantibody precedes the clinical symptoms and is thus predictive of preeclampsia. We therefore detected this antibody in serum from second trimester pregnancies with abnormal uterine perfusion because these women show an indirect sign of inadequate trophoblast invasion. Then the AT 1 autoantibody distribution/concentration was compared with that of women at term with or without pregnancy pathology. The AT 1 autoantibody was already detectable in second trimester pregnant women with abnormal uterine perfusion before the clinical manifestation of preeclampsia (80%). However, it was also found in second trimester pregnant women with abnormal uterine perfusion who later developed intrauterine growth retardation (60%) or even had a normal course of pregnancy (62%). In the third trimester, the AT 1 autoantibody was demonstrated in 89% of patients with manifest preeclampsia, 86% of those with manifest intrauterine growth retardation, and even in healthy pregnant women at term with a history of abnormal uterine perfusion in the second trimester. We conclude that the AT 1 autoantibody is an early but nonspecific marker for preeclampsia. The generation of this antibody seems to be associated with distinct types of pregnancy disorders resulting from impaired placental development. The AT 1 autoantibody may thus be causative for pathological uteroplacental perfusion. Key Words: angiotensin II Ⅲ antibodies Ⅲ hypertension, gestational Ⅲ preeclampsia Ⅲ pregnancy Ⅲ receptors, angiotensin P reeclampsia, a serious pregnancy-specific disorder characterized by proteinuria and hypertension after the 20th week of gestation, is still a leading cause of maternal and neonatal morbidity and mortality. The lack of preventive and causal treatment is mainly attributable to the fact that the etiology and pathophysiology are not understood. 1 Impairment of placental development and trophoblast invasion is thought to be causally associated with preeclampsia. Doppler ultrasound determination of uterine perfusion is a noninvasive tool for measuring uteroplacental vascular resistance and assessing the quality of the trophoblast invasion. 2 The trophoblast failed to develop adequately in pregnancies with abnormal uterine perfusion. Trophoblast invasion into the maternal compartment is thus impaired, and the pregnant uterus is not transformed into a low-resistance bed. Precisely this pathology is thought to be a pathogenetic feature of pregnancy complications such as preeclampsia or intrauterine growth retardation (IUGR). Abnormal uterine perfusion characterizes pregnancies at risk for these complications and precedes their clinical manifestation. H...

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“…In singleton pregnancies, there is now extensive literature reporting on the clinical utility of mid-trimester uterine artery Doppler examination, in both high-risk and unselected populations, summaries of which suggest that this technique can predict the development of subsequent PET and IUGR with sensitivities of around 50% and 30%, respectively, for a 5% screen-positive rate, depending upon criteria used [3][4][5][6][7] . This information allows rational risk stratification for planning of further antenatal care and identifies a high-risk group for use in intervention studies, such as those examining the effectiveness of low-dose aspirin in prevention of PET 8 .…”

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confidence: 99%

Routine uterine artery Doppler screening in twin pregnancies?

Sebire

2002

Ultrasound in Obstet & Gyne

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How useful is uterine artery Doppler flow velocimetry in the prediction of pre‐eclampsia, intrauterine growth retardation and perinatal death? An overview

Abstract: Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting pre-eclampsia, intrauterine growth retardation and perinatal death.

Cited by 256 publications

References 49 publications

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis

Angiotensin II Type 1 Receptor Agonistic Antibodies Reflect Fundamental Alterations in the Uteroplacental Vasculature

Routine uterine artery Doppler screening in twin pregnancies?

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